Provider Demographics
NPI:1093107724
Name:MITCHELL, NATHAN (SAC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:MR
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NATHAN MITCHELL, SAC
Mailing Address - Street 1:25480 E HINSDALE PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2198
Mailing Address - Country:US
Mailing Address - Phone:303-720-8050
Mailing Address - Fax:
Practice Address - Street 1:25480 E HINSDALE PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016
Practice Address - Country:US
Practice Address - Phone:303-720-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA0002003246ZC0007X
CO15-183246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSA0002003OtherSAC